201606-Bates-Tim-Dr-Wood-Benjamin-DrDr Tim Bates and Dr Benjamin Wood at SJG Midland Public Hospital.Midland by the numbers
It’s been six months since WA’s newest public hospital opened its doors and we thought it would be interesting to see what impact SJG Midland Public it has had in the eastern corridor. Due to our deadlines, these figures are a couple of weeks’ shy of the May 24 anniversary nevertheless, till that time 65,290 patients have been treated; 27,480 have presented and received medical care at the ED up 22% over a similar period at Swan District Hospital (SDH). More than 12,300 medical and surgical separations have taken place and about 660 babies have been born at the hospital with 30,900 outpatient visits. The 307-bed Hospital is expected to treat about 29,000 inpatients, 60,000 emergency patients and 102,000 outpatients in its first full year of operation.

Pork barrels and pathology
There’s perhaps no more dangerous creature than an election-campaigning politician. The PM in the first leaders’ debate announced that a deal had been struck with pathologists that would see bulk billing continue for blood tests in return for a ceasefire in Pathology Australia’s anti-government advertising campaign. The Government will also continue with its plan to cut pathology incentive payments, while introducing legislation to protect pathology companies from rent increases at collection centres. This move was roundly criticised by the RACGP, saying it would impact adversely on GP income. Budget black holes don’t get filled by spending more and the AMA chief Prof Brian Owler is on the money when he says this current agreement is not set in stone.

Too little too late
The PM’s back-down was too late for some smaller interstate pathology practices, which have closed or sold out to bigger conglomerates. Mind you, the increase in collecting centres for all community pathology providers after deregulation, might have affected their bottom line. According to the RCPA, $450m worth of testing was provided free during 2014-2015 due to the “buy three tests get the rest free” coning payment arrangement (increasing 12% since 1999-00).In WA, SJG Pathology is said to receive tax advantages over other pathology providers, and easier access to both the specialists (no coning rules) and inpatients in their hospitals, including hospitals such as Midland.

Close the cosmetic gaps201606-Botox-many-needles
In last month’s women’s edition we explored some of the sociological questions that arise from Female Cosmetic Genital Surgery. Last month the Medical Board’s 12-month examination of the cosmetic surgery industry was released in the form of new guidelines. Their thrust is consumer-focused with cooling off periods for consumers – a week for adults wanting major procedures and three months for under-18s who must also consult a registered psychologist, GP or psychiatrist. Under 18s only need to wait a week for minor procedures. Guidelines also place the responsibility for post-operative care and provision of proper emergency facilities in the lap of the medical practitioner, especially when using sedation, anaesthesia or analgesia. A mandatory consultation must also take place before a medical practitioner prescribes S4 cosmetic injectables; and they must provide the consumer with detailed written information about costs. Board head Dr Joanna Flynn said the report also identified problems for which it had no power to act – inconsistent drugs and poisons legislation across jurisdictions and the stricter licensing and regulation of private health facilities, particularly in their use of sedation and anaesthesia. Fremantle and PMH consultant Dr James Savundra, President of the Australian Society of Plastic Surgeons writing in Medical Observer urged state governments to implement laws to close these gaps. The guidelines come into effect on October 1.

Impartiality at ‘arms length’
You may have read in last month’s magazine that the WA Medical Board has been instructed to drop its case against Dr Keith Woollard because of a 10-year span in proceedings. Long waiting times figure prominently in the complaints made privately to us where doctors have waited many months to be exonerated. The April Medical Board news includes a message from the Chair Dr Joanna Flynn who writes that while the board’s primary concern is risk to the public, it doesn’t want to cause “avoidable distress to doctors” and pointed to the 2013 beyondblue study that found “very high levels of distress, anxiety, depression, substance misuse and suicidal ideation among doctors and medical students”. The Medical Board has given $2m of registration fees to the AMA, in part to set up Doctors’ Health Services Pty Ltd to “establish and administer the health programs at arms’ length”, to look after doctors’ health everywhere, with Vic and WA up in the air. We understand WA is the only State that has held onto its non-mandatory reporting of doctors. The AMA’s involvement may need some explaining to those WA doctors (June edition e-Poll, 2015, 195 respondents) who said the AMA was potentially part of the problem (moreso among non-AMA members) when it came to Medical Board impartiality. They may want to know more about what “arms length” entails. “By increasing national funding to doctors’ health programs, the Medical Board wants to contribute to building a resilient and strong profession which will benefit the wider community.”

Donor guidelines support families
Earlier this year, Assistant Health Minister Senator Fiona Nash released the long-awaited independent review into Australia’s organ donation system. It wasn’t the clean sweep some in the sector had wanted to see, rather it was a steady-as-she-goes approach with more support for the Organ Tissue Authority to lift donor rates. Senator Nash at the time ruled out an ‘opt-out’ model. Recently the NHMRC released new Ethical and Clinical Guidelines for organ transplantation which has a strong focus around supporting the decision-making of potential organ transplant recipients and their families, carers and friends. This complex and confronting issue perplexes the whole community. In this month’s ePoll we asked GPs for their thoughts of the process, in this instance at the renewal of a driver’s licence – and a hair’s breadth separates the two poles.

Q: How should organ donor status be outlined during renewal of a driver’s licence?
Opt-in by person renewing  45%
Opt-out                                 46%
Other                                      0%
Uncertain                                6%
None of the above                  3%